<div id="identifikasiColumn">
   <span class="cff6601 bold ">Pendaftaran <img src="<?=base_url();?>/images/iconask.jpg" /> </span></br>
   <table width="436">
    <tr>
       	<td width="214" height="30"> Daftar Sebagai</td>
   	<td width="10">:</td>
   	<td width="203">
            <select name="daftar" >
            <option value=0>Pilih Salah Satu</option>
            <option value="penjual">Penjual</option>
            <option value="pembeli">Pembeli</option>
            </select></td>
    </tr>
    <tr>
      	<td height="30"></td>
        <td></td>
       	<td><input type="radio" name="daftar" value="Perseorangan" />Perseorangan</td>
    </tr>
    <tr>
       	<td height="30"></td>
        <td></td><td><input type="radio" name="daftar" value="Badan Usaha Hukum" />Badan Usaha Hukum</td>
    </tr>
    <tr>
        <td colspan=3><HR width="100%"></td>
    </tr>
    <tr>
     	<td height="30"> Nama Lengkap</td>  
        <td>:</td><td><input type="text" name="namalengkap" value="" size="30"/></td>
    </tr>
    <tr>
      	<td height="30">No Telepon</td>   
        <td>:</td><td><input type="text" name="notelepon" value=""size="30"/></td>
    </tr>
    <tr>
      	<td height="30">Alamat Email </td> 
        <td>:</td><td><input type="text" name="alamatemail" value=""size="30"/></td>
    </tr>
    <tr>
      	<td height="30">Kode Verifikasi</td>  
        <td>:</td>
        <td>&nbsp;</td>
    </tr>
    <tr>
      	<td height="30"></td><td></td><td></td>
    </tr>
    <tr>
      	<td height="30"></td><td></td><td><input type="submit" value="Daftar" /></td>
    </tr>
    </table>
</div>
